Diagnosis Accuracy Clinical Reviewer

Diagnosis Accuracy Clinical Reviewer

HealthPartners is hiring a Diagnosis Accuracy Clinical Reviewer. This role is a highly skilled clinician to support the ongoing work of the Diagnosis Accuracy Program. The individual will review patient records to assess diagnosis code specificity, identify documentation and coding opportunities based on supporting clinical evidence, and validate suspect conditions.

Minimum Qualifications

• Education, Experience or Equivalent Combination:
• Advanced Practice Clinician either Master of Science in Nursing degree (Nurse Practitioner), Physician Assistant (PA), or Master's prepared Registered Nurse (RN) with clinical coding experience
• Minimum two years clinical experience
• Licensure/ Registration/ Certification:
• Maintain a current, active, unrestricted state licensed/certification as a Nurse Practitioner (NP), Physician Assistant (PA), or Registered Nurse (RN)
• Knowledge, Skills, and Abilities:
• Strong clinical background with in-depth knowledge of medical terminology, pathophysiology, pharmacology, and disease interactions, supported by sound clinical judgment and ability to interpret complex medical information.
• Strong and demonstrated PC skills are required along with an ability to learn new systems.
• Experience with electronic medical record and billing modules (e.g. Epic)
• Strong verbal, and written communication, skills
• Ability to work with others and develop consensus among differing parties.
• Knowledge of ICD-10 diagnosis coding, clinical documentation requirements, and clinical documentation improvement concepts
• Ability to self-direct work, detail orientated and organized
• Ability to manage and impart confidential information

Preferred Qualifications

• Education, Experience or Equivalent Combination:
• NA
• Licensure/ Registration/ Certification:
• Recommend Certified Professional Coder (CPC) or Certified Coding Specialist (CCS-P) Certification, AHIMA accredited Registered Health Information (RHIT), or Registered Health Information Administer (RHIA), Certified Documentation Expert Outpatient (CDEO)
• Recommend Certified Risk Coder (CRC) certification
• Certified Clinical Documentation Specialist Outpatient (CCDS-O)
• Knowledge, Skills, and Abilities:
• Knowledge of multiple payment and risk adjustment methodologies used by government and commercial payers
• Ability to work collaboratively with others
• Ability to work in an ever-changing environment with differing perspectives and ability to resolve situations effectively

Essential Duties

1. (75%) - Conduct chart review of patient medical records prior to clinic visits including chart notes, labs, medications, x-rays, etc. This includes reviewing clinical criteria, suspect conditions, updating the patient problem list, and evaluation of outreach opportunities.
2. (10%) - Support chart reviews outside the clinic visit including payer identified reviews.
3. (10%) - Support program on clinically focused projects (e.g., best practices, quality, condition specific chart reviews, condition specific tools).
4. (5%) - Other duties as assigned.

About Us

At HealthPartners we believe in the power of good good deeds and good people working together. As part of our team, you'll find an inclusive environment that encourages new ways of thinking, celebrates differences, and recognizes hard work.

We're a nonprofit, integrated health care organization, providing health insurance in six states and high-quality care at more than 90 locations, including hospitals and clinics in Minnesota and Wisconsin. We bring together research and education through HealthPartners Institute, training medical professionals across the region and conducting innovative research that improve lives around the world.

At HealthPartners, everyone is welcome, included and valued. We're working together to increase diversity and inclusion in our workplace, advance health equity in care and coverage, and partner with the community as advocates for change.

Benefits Designed to Support Your Total Health As a HealthPartners colleague, we're committed to nurturing your diverse talents, valuing your dedication, and supporting your work-life balance. We offer a comprehensive range of benefits to support every aspect of your life, including health, time off, retirement planning, and continuous learning opportunities. Our goal is to help you thrive physically, mentally, emotionally, and financially, so you can continue delivering exceptional care.

Join us in our mission to improve the health and well-being of our patients, members, and communities.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran and basis of disability or any other federal, state or local protected class.